Unveiling spatial inequalities: Exploring county-level disaster damages and social vulnerability on public disaster assistance in contiguous US.

Understanding the dynamics between public disaster assistance, disaster damages, and social vulnerability at county-level is crucial for designing effective disaster mitigation strategies. This study utilized the Local Bivariate Moran Index (LBMI) and geographically weighted regression (GWR) models to examine spatial patterns and relationships between disaster damages, social vulnerability, and public disaster assistance in contiguous US counties from 2001 to 2021. LBMI results reveal that public disaster assistance has predominantly been directed towards post-disaster recovery efforts, with a particular focus on coastal communities affected by major declared disasters. However, the distributions of public assistance and individual housing assistance, which are the two primary sources of public disaster assistance, do not adequately cover physically and socially vulnerable communities. The distribution of pre-disaster risk mitigation also falls short of sufficiently covering vulnerable communities. Results further indicate the complex interactions between different categories of natural disasters and public assistances. The GWR model results demonstrate spatial variations in predicting each category of public disaster assistance. These findings indicate the need to address disparities in accessing public disaster assistance in the US, and advocate for more equitable disaster mitigation strategies.

Prevalence of dental visits in older Japanese adults receiving public assistance.

OBJECTIVES: Exemption from paying dental care costs among recipients of public assistance contributes to universal health care coverage. Although this system might reduce the financial barriers to dental care among patients, there are still several other barriers for public assistance recipients. Therefore, this study examined whether receiving public assistance was associated with a higher prevalence of dental visits for any reason, treatment and prevention. METHODS: Data were obtained from 16 366 respondents from the 2019 wave of a nationwide cohort study on older adults in Japan. Poisson regression analyses with robust error variance were used to examine the associations between receiving public assistance and dental visits, adjusting for number of teeth, dental pain, periodontal conditions, age, sex, number of family members, education, equivalent household income, working status, instrumental activities of daily living, medical conditions, depressive symptoms, instrumental support and geographical variations. RESULTS: More than half of the non-recipients of public assistance visited a dentist for some reason in the past 6 months. Meanwhile, only 37% of the recipients visited a dentist. In addition, almost half of the non-recipients had treatment visits, while only 34% of the recipients visited. Furthermore, 46% of the non-recipients had dental visits for prevention, while 32% of the recipients had preventive visits. In the fully adjusted models, compared to non-recipients, public assistance recipients were 24% (Prevalence Ratio [PR]: 0.76, 95% Confidence Intervals [CI]: 0.64, 0.90), 23% (PR: 0.77, 95% CI: 0.65, 0.92) and 21% (PR: 0.79, 95% CI: 0.65, 0.95) less likely to have dental visits for any reason, treatment, and prevention, respectively. CONCLUSIONS: Although recipients were exempted from dental treatment fees, receiving public assistance was associated with a lower prevalence of dental visits for any reason, treatment and prevention. Future studies should identify the barriers to accessing dental care among public assistance recipients to improve dental visits.

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity.

Importance: Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity. Objective: To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity. Design, Setting, and Participants: This cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023. Exposures: Annual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs. Main Outcomes and Measures: Race- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year. Results: A total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) (P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term). Conclusions and Relevance: These results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States' eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.

Un encuentro inesperado: evocando a José María Arguedas durante su paso por la Asistencia Pública de Grau / Um encontro inesperado: evocar José María Arguedas durante a sua passagem pelo Centro de Assistência Pública de Grau / An unexpected encounter: evoking José María Arguedas during his stay at the Grau Public Assistance Health Center

The present article contributes with additional information, until now very little known, from the moment when the great Peruvian writer José María Arguedas, wounded of death product of had been inflicted with a bullet in the head which provoked him to be transferred from the National Agrarian University towards the Employee's Hospital. On the way, it is noted that a stop was made, until now scarcely known, that happened in the Post of the Grau Public Assistance Health Center, in the afternoon of Friday November 28, 1969. That day, as a consequence of a strong intestinal infection, the author of this article was being treated in the same Health Center, finding himself sharing the same room, during that time with the alleged writer.(AU)

El presente artículo contribuye con información adicional, hasta ahora muy poco conocida, cuando el gran escritor peruano José María Arguedas, herido de muerte producto de haberse infligido un balazo en la cabeza es trasladado desde la Universidad Nacional Agraria hacia el Hospital del Empleado. En el trayecto, se hace notar que se hizo una escala, hasta ahora escasamente conocida, que ocurrió en el Puesto de la Asistencia Pública de Grau, en la tarde del viernes 28 de noviembre de 1969. Ese día a consecuencia de una fuerte infección intestinal, el autor del presente artículo fue atendido de emergencia en la Asistencia Pública de Grau, compartiendo la misma habitación, durante el tiempo que permaneció el escritor en aquel centro asistencial de salud.(AU)

Este artigo contribui com informações adicionais, até agora pouco conhecidas, quando o grande escritor peruano José María Arguedas, mortalmente ferido por ter levado um tiro na cabeça, é transferido da Universidade Nacional Agrária para o Hospital do Empregado. No caminho, nota-se que foi feita uma escala, até agora pouco conhecida, que ocorreu no Posto de Atendimento Público de Grau, na tarde de sexta-feira, 28 de novembro de 1969. Naquele dia em consequência de uma forte infecção intestinal, o autor deste artigo foi atendido no pronto-socorro da Assistência Pública do Grau, compartilhando o mesmo quarto, durante o tempo que o escritor permaneceu naquele centro de saúde.(AU)

Sociodemographic inequities in unscheduled asthma care visits among public assistance recipients in Japan: additional risk by household composition among workers.

BACKGROUND: Public assistance programs aim to prevent financial poverty by guaranteeing a minimum income for basic needs, including medical care. However, time poverty also matters, especially in the medical care adherence of people with chronic diseases. This study aimed to examine the association between the dual burden of working and household responsibilities, with unscheduled asthma care visits among public assistance recipients in Japan. METHODS: This retrospective cohort study included public assistance recipients from two municipalities. We obtained participants' sociodemographic data in January 2016 from the public assistance database and identified the incidence of asthma care visits. Participants' unscheduled asthma visits and the frequency of asthma visits were used as the outcome variables. Unscheduled visits were defined as visits by recipients who did not receive asthma care during the first three months of the observation period. Participants' age, sex, household composition, and work status were used as explanatory variables. Multiple Poisson regression analyses were performed to calculate the cumulative incidence ratio (IR) with a 95% confidence interval (CI) of unscheduled visits across the explanatory variables. The effect of modification on the work status by household composition was also examined. RESULTS: We identified 2,386 recipients at risk of having unscheduled visits, among which 121 patients (5.1%) had unscheduled visits. The multivariable Poisson regression revealed that the working recipients had a higher incidence of unscheduled visits than the non-working recipients (IR 1.44, 95% CI 1.00-2.07). Among working recipients, the IRs of unscheduled visits were higher among recipients cohabiting with adults (IR 1.90 95% CI 1.00-3.59) and with children (IR 2.35, 95% CI 1.11-4.95) than for recipients living alone. Among non-working recipients, the IRs of unscheduled visits were lower for recipients living with family (IR 0.74, 95% CI 0.41-1.35) and those living with children (IR 0.50, 95% CI 0.20-1.23). A higher frequency in asthma visits was observed among working recipients living with family. CONCLUSIONS: Working adults cohabiting with children are at the greatest risk of unscheduled visits among adults receiving public assistance. To support healthy lifestyles of public assistance recipients, medical care providers and policymakers should pay special attention to the potentially underserved populations.

State Public Assistance Spending and Survival Among Adults With Cancer.

Importance: Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations. Objective: To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity. Design, Setting, and Participants: This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023. Exposure: Differential state-level public assistance spending. Main Outcome and Measure: The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage. Results: A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects). Conclusions and Relevance: This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.

Identifying meaningful subpopulation segments among older public assistance recipients: a mixed methods study to develop tailor-made health and welfare interventions.

BACKGROUND: Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the population into subgroups (segments) with similar sociodemographic characteristics, is a useful approach for allocating support resources to the targeted segments. Clustering is a commonly used statistical method of segmentation in a data-driven marketing approach. This explanatory sequential mixed methods study applied a clustering technique, aiming to identify segments among older public assistance recipients quantitatively, and assess the meaningfulness of the identified segments in consultation and support activities for older recipients qualitatively. METHODS: We identified the segments of older recipients in two municipalities using probabilistic latent semantic analysis, a machine learning-based soft clustering method. Semi-structured interviews were subsequently conducted with caseworkers to ask whether the identified segments could be meaningful for them in practice and to provide a reason if they could not think of any older recipients from the segment. RESULTS: A total of 3,165 older people on public assistance were included in the analysis. Five distinct segments of older recipients were identified for each sex from 1,483 men and 1,682 women. The qualitative findings suggested most of identified segments reflected older recipients in practice, especially two of them: female Cluster 1 (facility residents aged over 85 years with disability/psychiatric disorder), and female Cluster 2 (workers). Some caseworkers, however, did not recall older recipients in practice when working with certain segments. CONCLUSIONS: A clustering technique can be useful to identify the meaningful segments among older recipients and can potentially discover previously unrecognized segments that may not emerge through regular consultation practices followed by caseworkers. Future research should investigate whether tailored support interventions for these identified segments are effective.

The Impact of Temporary Assistance for Needy Families Benefit Requirements and Sanctions on Maternal Material Hardship, Mental Health, and Parental Aggravation.

INTRODUCTION: Temporary Assistance for Needy Families requirements can be stress-inducing, difficult for families to complete, and may be detrimental during early life. We assessed the impact of TANF requirements on primary caregiving mothers' experiences of material hardship, anxiety, depression, and parental aggravation in the first year of a child's life. METHODS: Survey responses were selected from mothers in the Future of Families and Childhood Wellbeing Study, who received TANF in the first year of their child's life (N = 1085). RESULTS: Survey-weighted regression models showed associations between: presence of any requirements and increased material hardship, work requirements and increased material hardship, requirement to name the father of their child and increased depression, benefit cuts and increased parental aggravation, and benefit cuts and increased material hardship. DISCUSSION: Federal and state policies should revise requirement programs to increase program accessibility and support the mental health and financial stability of mothers applying for TANF to facilitate sustainable movement into employment.

Assessment of Medical and Public Assistance Expenditures and Employment Among US Adults With Cancer Diagnoses.

Importance: Prior research suggests significant social value associated with increased longevity due to preventing and treating cancer. Other social costs associated with cancer, such as unemployment, public medical spending, and public assistance, may also be sizable. Objective: To examine whether a cancer history is associated with receipt of disability insurance, income, employment, and medical spending. Design, Setting, and Participants: This cross-sectional study used data from the Medical Expenditure Panel Study (MEPS) (2010-2016) for a nationally representative sample of US adults aged 50 to 79 years. Data were analyzed from December 2021 to March 2023. Exposure: Cancer history. Main Outcomes and Measures: The main outcomes were employment, public assistance receipt, disability, and medical expenditures. Variables for race, ethnicity, and age were used as controls. A series of multivariate regression models were used to assess the immediate and 2-year association of a cancer history with disability, income, employment, and medical spending. Results: Of 39 439 unique MEPS respondents included in the study, 52% were female, and the mean (SD) age was 61.44 (8.32) years; 12% of respondents had a history of cancer. Individuals with a cancer history who were aged 50 to 64 years were 9.80 (95% CI, 7.35-12.25) percentage points more likely to have a work-limiting disability and were 9.08 (95% CI, 6.22-11.94) percentage points less likely to be employed compared with individuals in the same age group without a history of cancer. Nationally, cancer accounted for 505 768 fewer employed individuals in the population aged 50 to 64 years. A cancer history was also associated with an increase of $2722 (95% CI, $2131-$3313) in medical spending, $6460 (95% CI, $5254-$7667) in public medical spending, and $515 (95% CI, $337-$692) in other public assistance spending. Conclusions and Relevance: In this cross-sectional study, a history of cancer was associated with increased likelihood of disability, higher medical spending, and decreased likelihood of employment. These findings suggest there may be gains beyond increased longevity if cancer can be detected and treated earlier.

O esporte e o lazer no programa nacional de assistência estudantil: revisão sistemática da literatura / Sport and leisure in the national student assistance program: systematic literature review

Objetivou-se analisar as publicações sobre esporte e lazer no contexto da assistência estudantil nas bases de referências e averiguar a aderência do esporte e lazer como uma ação da política de assistência estudantil nas instituições federais de ensino superior. Trata-se de uma revisão sistemática da literatura estruturada em 8 passos: definição dos tópicos da pesquisa; escolha das bases; escolha das palavras-chave; pesquisa e armazenamento dos resultados encontrados; seleção dos materiais por resumo, considerando os critérios de inclusão/exclusão; extração de dados dos trabalhos selecionados; avaliação do material encontrado; e síntese e interpretação dos dados. O estudo é original por ser pioneiro em investigar, de maneira sistemática, a discussão do esporte e lazer no contexto da assistência estudantil. Ao agrupar as publicações e estruturar agenda de pesquisa, a partir do PNAES, garante ao estudo a originalidade e a relevância ao campo. Os principais resultados demonstram que a maioria dos estudos focam na verificação das ações prioritárias do PNAES desenvolvidas pelas IFES, seguida da avaliação da implementação do PNAES e o debate sobre o papel das IFES na formulação de políticas de esporte e lazer. O estudo amplia a discussão teórica do esporte como ação integrante no rol da assistência estudantil para além da figura de subsidiária das outras ações, além de estruturar indicações e sugestões de pesquisas futuras.

The objective was to analyze the publications on sport and leisure in the context of student assistance in the reference bases and to verify the adherence of sport and leisure as an action of the student assistance policy in federal institutions of higher education. This is a systematic review of the literature structured in 8 steps: definition of research topics; choice of bases; choice of keywords; search and storage of the results found; selection of materials by summary, considering the inclusion/exclusion criteria; data extraction from selected works; evaluation of the material found; and synthesis and interpretation of data. The study is original for being a pioneer in systematically investigating the discussion of sport and leisure in the context of student assistance. By grouping the publications and structuring the research agenda, based on the PNAES, it guarantees the study originality and relevance to the field. The main results show that most studies focus on verifying the priority actions of the PNAES developed by the IFES, followed by the evaluation of the implementation of the PNAES and the debate on the role of the IFES in the formulation of sports and leisure policies. The study extends the theoretical discussion of sport as an integral action in the role of student assistance beyond the subsidiary figure of other actions, in addition to structuring indications and suggestions for future research.

Forming the Perception of WIC Infant Feeding Recommendations: A Qualitative Study.

Nearly half of newborns in the United States are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Promoting breastfeeding is a programmatic priority, although formula vouchers are provided for those who do not exclusively breastfeed. Previous literature suggests that participant perception of WIC's breastfeeding recommendations is a significant factor predicting breastfeeding initiation, duration, and exclusivity outcomes. However, little is known about how participants' perceptions of WIC's breastfeeding recommendations are formed. To address this knowledge gap, we conducted a qualitative pilot study in Nevada, interviewing 10 postpartum WIC mothers and 12 WIC staff who had interacted with participants regarding infant feeding. Results showed participants and staff reported various perceptions of what WIC recommends, the factors that contribute to these perceptions, and how these perceptions affect breastfeeding practices. Respondents also described that WIC has a negative legacy as the "free formula program," and that environmental factors, such as the recent formula recall, have had an impact on participants' infant feeding practices. More effective public campaigns and programmatic strategies are needed to target participants' prenatal self-efficacy and to communicate the availability of skilled lactation support in the early postpartum period to improve participants' perceptions of WIC's position on breastfeeding.

Copay assistance use and prescription abandonment across race, ethnicity, or household income levels for select rheumatoid arthritis and oral oncolytic medicines.

BACKGROUND: Disparities in prescription abandonment may exacerbate health inequities. Whether copay assistance is associated with changes in prescription abandonment across different patient groups is unknown. OBJECTIVE: To assess disparities in copay assistance use; prescription abandonment across race, ethnicity, or income; and association of copay use with prescription abandonment and whether it differs across race, ethnicity, or household income. METHODS: This pooled, cross-sectional study assessed claims-level prescription data linked to a consumer database containing information on race, ethnicity, and household income for commercially insured patients. The first prescription for rheumatoid arthritis (RA) or oral oncolytic medicines from 2016 to 2020 was included. Logistic regression models measured odds of copay assistance use (copay/discount cards or free-trial voucher) and prescription abandonment (prescription not filled within 30 days of health plan approval). Interaction terms for copay assistance use by race, ethnicity, and income were tested. RESULTS: The sample included 67,674 patients prescribed RA medications and 9,560 prescribed oral oncolytic medications. Copay assistance use across race, ethnicity, and income ranged from 28.2% to 31.1% (RA medicines) and 27.2% to 36.7% (oral oncolytic medicines). Among those prescribed RA medicines and not using copay assistance, Black/African American, Hispanic patients, and those with household incomes less than $50,000 were more likely to abandon prescriptions than White patients and patients with household incomes more than $200,000 (odds ratio [OR] [95% CI], P value: Black/African American: 1.17 [1.06-1.29], P < 0.01; Hispanic: 1.11 [1.01-1.22], P = 0.03; income <$50,000: 1.24 [1.11-1.37], P < 0.01). Among patients using oral oncolytic medicines and not using copay assistance, there was no racial or ethnic difference in prescription abandonment. Patients using oral oncolytics with household incomes less than $50,000 were more likely to use copay assistance (1.34 [1.12-1.61], P < 0.01), but also more likely to abandon their prescriptions if not using copay assistance (1.44 [1.12-1.85], P < 0.01). Copay assistance was associated with a 79% (RA) and 71% (oral oncolytics) lower odds of prescription abandonment (0.21 [0.19-0.24], P < 0.01; 0.29 [0.24-0.36], P < 0.01), which did not differ across race, ethnicity, or income levels (P > 0.05). CONCLUSIONS: Copay assistance has potential to narrow disparities in prescription abandonment for commercially insured Black/African American or Hispanic patients taking RA medicines and patients with household incomes less than $50,000; however, efforts to improve access to copay assistance are needed. Copay assistance, as a factor facilitating equal access to medicines, is an important consideration when evaluating policies that impact access to copay assistance programs. DISCLOSURES: Genentech, Inc., provided funding and support for this study. Dr Wong is an employee of Genentech, Inc., and shareholder of Roche, Inc. Ms Donahue, Mr Thiesen, and Mr Yeaw are employees of IQVIA.

Temporary Assistance For Needy Families: Sanctioning And Child Support Compliance Among Black Families In Illinois.

Temporary Assistance for Needy Families (TANF) is a federal cash welfare program for low-income, working families with children in the United States that requires participation with child support enforcement, if one parent is noncustodial, to receive the cash benefit. Cash assistance has been linked to improved child health and academic achievement, but sanctions to benefits can increase health risks. Our community-engaged, mixed-methods research project sought to identify barriers to TANF among families with young children in Illinois. In this study we analyzed TANF sanctions related to child support enforcement, using analysis of TANF administrative data and semistructured interviews with TANF customers. We conducted logistic regression and Fisher's test to explore demographic differences in sanctioning and sanction types. Black families were 111 percent more likely than White families to receive at least one sanction in 2018-19. Black families who were enrolled in TANF received more sanctions for child support noncompliance (2018: 42 percent; 2019: 50 percent) than White families (2018: 30 percent; 2019: 34 percent). Mothers who were survivors of intimate partner violence voiced particular challenges with child support compliance. Policy recommendations include shifting to alternative cash assistance models and removing pass-through funding so that families receive the full child support benefit.

Bolsa Família Program and deaths from oral cancer in Brazil: an ecological study

[ABSTRACT]. Objective. To assess the effect of coverage of the Bolsa Família Program (BFP) on oral cancer mortality rates in Brazil between 2005 and 2017, adjusting for health care coverage and socioeconomic characteristics of the Brazilian federative units. Methods. This is an ecological study using annual data (2005–2017) from all the Brazilian federative units. The dependent variable for this study was the oral cancer mortality rate, standardized by gender and age using the direct standardization technique. BFP coverage was the main independent variable, calculated as the ratio of the number of BFP beneficiaries to those families that should potentially be entitled to this conditional cash transfer. Socioeconomic background and health care coverage were covariables. Choropleth maps were drawn, and space-time cube analysis was used to assess changes in the spatiotemporal distribution of BFP and oral cancer mortality rates. Mixed-effects linear regression analysis estimated the coefficients (β) and 95% confidence intervals (CI) for the association between BFP coverage and oral cancer mortality rates. Results. BFP coverage trends increased and oral cancer mortality rate trends stabilized in Brazilian federative units, except for Maranhão, Goiás, and Minas Gerais, where the oral cancer mortality rates have increased. In the adjusted model, greater BFP coverage was associated with lower oral cancer mortality rates (β –2.10; 95% CI [–3.291, –0.919]). Conclusions. Egalitarian strategies such as BFP can reduce the oral cancer mortality rate. We recommend the follow-up of families benefiting from conditional cash transfer program by oral health teams to reduce the oral cancer mortality rate.

[RESUMEN]. Objetivo. Evaluar el efecto de la cobertura del Programa Bolsa Família (BFP) en las tasas de mortalidad por cáncer de la cavidad bucal en Brasil entre el 2005 y el 2017, ajustadas por cobertura de atención de salud y características socioeconómicas de las unidades federativas brasileñas. Métodos. Este es un estudio ecológico con datos anuales (2005-2017) de todas las unidades federativas brasileñas. La variable dependiente de este estudio fue la tasa de mortalidad por cáncer de la cavidad bucal, estandarizada por sexo y edad mediante la técnica de estandarización directa. La cobertura del BFP fue la principal variable independiente, calculada como la relación entre el número de beneficiarios del BFP y las familias que podrían tener el derecho a recibir esta transferencia monetaria condicionada. Los antecedentes socioeconómicos y la cobertura de atención de salud fueron covariables. Se trazaron mapas coropléticos y se realizó un análisis con cubos espaciotemporales para evaluar los cambios en la distribución espaciotemporal del BFP y las tasas de mortalidad por cáncer de la cavidad bucal. El análisis de regresión lineal de efectos mixtos calculó los coeficientes (β) y los intervalos de confianza (IC) del 95% para la relación entre la cobertura del BFP y las tasas de mortalidad por cáncer de la cavidad bucal. Resultados. Las tendencias de cobertura del BFP aumentaron y las tendencias de la tasa de mortalidad por cáncer de la cavidad bucal se estabilizaron en las unidades federativas brasileñas, excepto en Maranhão, Goiás y Minas Gerais, donde estas tasas aumentaron. En el modelo ajustado, una mayor cobertura del BFP se asoció con tasas más bajas de mortalidad por cáncer de la cavidad bucal (β –2,10; IC del 95% [–3,291, –0,919]). Conclusiones. Las estrategias igualitarias como el BFP pueden reducir la tasa de mortalidad por cáncer de la cavidad bucal. Recomendamos el seguimiento por parte de los equipos de salud bucodental de las familias que se benefician del programa de transferencias monetarias condicionadas para reducir la tasa de mortali- dad por cáncer de la cavidad bucal.

[RESUMO]. Objetivo. Avaliar o efeito da cobertura do Programa Bolsa Família (PBF) sobre as taxas de mortalidade por câncer bucal no Brasil entre 2005 e 2017, com ajuste para a cobertura de saúde e as características socio- econômicas das unidades federativas brasileiras. Métodos. Este é um estudo ecológico com base em dados anuais (2005-2017) de todas as unidades feder- ativas brasileiras. A variável dependente foi a taxa de mortalidade por câncer bucal, padronizada por sexo e idade pela técnica de padronização direta. A cobertura do PBF foi a principal variável independente, cal- culada como a razão entre o número de beneficiários do PBF e de famílias que deveriam ter direito a essa transferência condicionada de renda. O contexto socioeconômico e a cobertura de saúde foram covariáveis. Elaboraram-se mapas coropléticos e usou-se a análise de cubo espaço-temporal para avaliar variações da distribuição espaço-temporal do PBF e das taxas de mortalidade por câncer bucal. A análise por regressão linear de efeitos mistos estimou os coeficientes (β) e intervalos de confiança (IC) de 95% da associação entre cobertura do PBF e taxas de mortalidade por câncer bucal. Resultados. Houve aumento da tendência de cobertura do PBF e estabilização da tendência da taxa de mortalidade por câncer bucal nas unidades federativas brasileiras, com exceção dos estados de Maranhão, Goiás e Minas Gerais, onde as taxas de mortalidade por câncer bucal aumentaram. No modelo ajustado, a maior cobertura do PBF foi associada a menores taxas de mortalidade por câncer bucal (β -2,10; IC 95% [-3,291, -0,919]). Conclusões. Estratégias igualitárias como o PBF podem reduzir a taxa de mortalidade por câncer bucal. Recomendamos o acompanhamento das famílias beneficiadas por programas de transferência condicionada de renda por equipes de saúde bucal para reduzir a taxa de mortalidade por esse câncer.

Características actuales de la población pediátrica asistida en un centro de salud del primer nivel de atención en 2020-2021: Montevideo, Uruguay / Characteristics of the pediatric population assisted at primary care level in Montevideo, Uruguay / Características da população pediátrica assistida no nível de atenção primária em Montevidéu, Uruguai

Introducción: alrededor del 30% de las enfermedades infantiles responden a factores sociofamiliares y ambientales, asociados a condiciones de vida, dinámica familiar y exposición a sustancias tóxicas. Conocer las características de la población pediátrica que asiste este centro de salud nos ayudará a identificar factores que pueden estar influyendo en su salud. Objetivos: Describir las características clínico-epidemiológicas de la población menor de 15 años que recibió asistencia en el Centro de Salud Badano Repetto en el período 2020-2021. Conocer diferentes variables que pueden influir en la salud de esta población Identificar asociación de variables familiares y socioculturales con el desarrollo en las diferentes edades. Metodología: estudio descriptivo, retrospectivo, corte transversal. Se incluyó una muestra por conveniencia del 15% del total de los niños y adolescentes menores de 15 años asistidos en el centro de salud desde 1/10/2020 hasta 31/3/2021. Variables estudiadas: del niño: sexo, edad, antecedentes perinatales, crecimiento y desarrollo, controles en salud, inmunizaciones, escolarización, actividades extracurriculares. De los padres: edad, nivel educativo, consumo de sustancias psicoactivas, antecedentes patológicos, empleo, privación de libertad. Familia y vivienda: estado civil de los padres, antecedentes de violencia doméstica, convivientes, características de la vivienda, servicios básicos, transferencias directas de ayuda, intervención de equipos de territorio. Fuente de datos: historias clínicas y vía telefónica. Registro en planilla prediseñada. Los resultados se expresan en frecuencias absolutas, relativas y medidas de tendencia central con su rango. Se utilizó test de Chi cuadrado o exacto de Fisher. Nivel de significación: 0,05. Programa Epi Info™ versión 7.2. Consentimiento informado telefónico a padres y asentimiento a adolescentes. Aprobado por el Comité de Ética del CHPR. Resultados: consultaron 2.826 menores de 15 años, se incluyeron 426 (15%), pero solo 263 (62%) fueron analizados, dado que 163 (38%) no pudieron ser contactados telefónicamente. El 52% eran de sexo femenino. Media de edad: 4 años (5 días-14 años), 69% ≤5 años. 83% de los pacientes tenían adecuados controles de salud y 91% estaban al día con sus inmunizaciones. 12% tenían sobrepeso/obesidad. El desarrollo neurológico fue adecuado en 93% en los menores de 5 años y en 56% de los mayores de 5 años de edad. En el caso de aquellos con trastornos del neurodesarrollo mayores de 5 años, 46% tenían trastornos del aprendizaje, 39% trastorno de conducta, 32% trastornos del lenguaje, 10% déficit intelectual. 56% estaba escolarizado, todos en escuelas públicas. En el caso de aquellos que no asistían a la escuela, 4 estaban en edad de asistencia obligatoria (6, 7, 9 y 10 años de edad). 20% de los niños/adolescentes había repetido por lo menos un año en escuela o liceo. Datos perinatales: 14% de las madres consumieron drogas; las más frecuentes fueron tabaco y pasta base de cocaína (PBC). 85% fueron recién nacidos de término, 10% presentaron depresión neonatal. 15% de niños/ adolescentes estuvo expuesto a violencia doméstica y 32% de ellos (12/38) tenía por lo menos un padre con uso de drogas psicoactivas en el domicilio. 21% de los niños/adolescentes expuestos a violencia doméstica tenía una dificultad de aprendizaje. 8% de estos pacientes tenía por lo menos un padre que no había terminado educación primaria y 28% que no había terminado ciclo básico. Se encontró una relación significativa entre uso de drogas psicoactivas, declarada por uno o ambos padres, y violencia doméstica. No se encontró una relación significativa entre alteración del neurodesarrollo y violencia doméstica. Conclusiones: estos hallazgos muestran una población social y económicamente vulnerable, padres con baja escolaridad, uso de pasta base de cocaína durante el embarazo en un porcentaje mayor al reportado nacionalmente, y 15% de niños/adolescentes expuestos a violencia doméstica, pero con un buen número de controles de salud. La mayor fortaleza encontrada por este estudio es la importancia de mantener una buena conexión con estas familias, que mostraron un alto nivel de compromiso con el centro de salud. Esto nos desafía a priorizar la prevención y promoción en salud como herramientas valiosas para adquirir salud de calidad para estos niños/adolescentes. Nuevos estudios, con otras metodologías, serán necesarios para analizar estas variables encontradas.

Introduction: around 30% of childhood diseases are caused by social, environmental and family issues, as well as by life conditions, family dynamics and exposure to toxic substances. Understanding the characteristics of the pediatric population assisted at this Health Center, will help us identify health-threatening factors. Objectives: Describe the clinical and epidemiological characteristics of the population under 15 years of age assisted at Badano Repetto Health Center between 2020 and 2021. Understand the different variables that could influence this population´s health. Identify the link between family, social and cultural variables and neurological development at different ages. Methodology: descriptive, retrospective cross-sectional study. Convenience sampling of 15% of the total number of children and adolescents under 15 years of age, assisted at the Health Center from 10/01/2020 to 3/31/2021. Variables: children: sex, age, perinatal history, growth and neurological development, health checkups, vaccines, school attendance, extracurricular activities. Parents: age, education, psychoactive substance use, pathological background, job, prison. Family and household: parent`s marital status, domestic violence history, cohabitants, housing characteristics, basic household services, government aids, community interventions. Data source: medical records and telephone conversations. Data was recorded on template charts. We used results in absolute and relative frequencies, and their measures of central tendency measures and their range, Chi-square test or Fisher´s exact test. Significance level 0,05. Epi Info Program, version 7.2. Informed parent and adolescent consent. Approved by the CHPR Ethics Committee. Results: out of the 2826 patients under 15 years of age assisted at the clinic, we included 426 (15%), but only 263 (62%) were analyzed, since we were not able to reach 163 (38%) by phone. 52% were female. The average age was 4 years of age (5 days-14 years old). 69% of children were under 5 years old. 83% of patients had adequate number of checkups and 91% had an updated vaccination chart. 12% were overweight/obese. Neurodevelopment was adequate in 93% of those under 5 years of age, and 56% of those over 5 years of age. Regarding those with neurodevelopmental difficulties and over 5 years of age, 46% had learning disabilities, 39% had behavioral disorders, 32% language disorders, 10% intellectual deficit. 56% attended school, all of them public schools. For those who did not attend school, 4 of them were old enough to attend mandatory school (6, 7, 9 and 10 years of age). 20% of the children and adolescents had failed at least one year in school or high school. Perinatal findings: 14% of mothers had substance use during pregnancy, mainly tobacco and cocaine base paste. 85% of them had been born to term, 10% had neonatal depression 15% of children/adolescents had been exposed to domestic violence and 32% of them (12/38) had one parent with psychoactive drug use at home. 21% of children/adolescents exposed to domestic violence had a learning disability. 8% had at least one parent who did not finish primary school and 28% who did not finish middle school. Statistically, a significant link was found between psychoactive substance use, declared by one or both parents, and domestic violence. No statistically significant link was found between neurodevelopmental difficulties and domestic violence. Conclusions: these findings show a socially and economically vulnerable population, parents with little formal education, higher cocaine paste base use during pregnancy than the national statistics and 15% of children/adolescents exposed to domestic violence, even though they a high number of them had received their health checkups. The biggest strength shown by this study is the importance of maintaining a good bond with these families, who showed a high level of commitment with the health center. This leads us to prioritize health prevention and promotion as a valuable tool to achieve health quality standards for these children and adolescents. New studies, using other methodologies, will be necessary to analyze this data.

Introdução: cerca de 30% das doenças infantis são causadas por questões sociais, ambientais e familiares, bem como por condições de vida, dinâmica familiar e exposição a substâncias tóxicas. Compreender as características da população pediátrica atendida neste Centro de Saúde, nos ajudará a identificar fatores de risco à saúde. Objetivos: Descrever as características clínico-epidemiológicas da população menor de 15 anos de idade atendida no Centro de Saúde Badano Repetto no período 2020-2021. Compreender diferentes variáveis que podem influenciar a saúde dessa população. Identificar uma relação entre as variáveis familiares e socioculturais e o desenvolvimento em diferentes idades. Metodologia: estudo descritivo, retrospectivo, transversal. Foi incluída uma amostra por conveniência de 15% de todas as crianças e adolescentes menores de 15 anos atendidos no Centro de Saúde entre 01/10/2020 e 31/03/2021. Variáveis estudadas: da criança: sexo, idade, história perinatal, crescimento e desenvolvimento, controles de saúde, imunizações, escolaridade, atividades extracurriculares. Dos pais: idade, escolaridade, consumo de substâncias psicoativas, histórico médico, emprego, privação de liberdade. Família e habitação: estado civil dos pais, história de violência doméstica, coabitantes, características da moradia, serviços básicos, transferências de ajuda de custo, intervenção das equipes no território. Fonte de dados: prontuários e enquetes telefônicas. Cadastro em planilha padrão. Os resultados são expressos em frequências absolutas e relativas e medidas de tendência central com sua amplidão. Utilizou-se o teste do qui-quadrado ou exato de Fisher. Nível de significância 0,05. Programa Epi Info™ versão 7.2. Consentimento informado por telefone pais e consentimento dos adolescentes. Aprovado pelo Comitê de Ética do CHPR. Resultados: 2.826 crianças menores de 15 anos consultadas, 426 (15%) foram incluídas, mas 263 (62%) foram analisadas, pois 163 (38%) não puderam ser contatadas por telefone. 52% eram do sexo feminino. Idade média 4 anos (5 dias -14 anos), 69% ≤ 5 anos. 83% dos pacientes possuíam controles de saúde adequados e 91% estavam com suas imunizações em dia. 12% com sobrepeso/obesidade. O desenvolvimento neurológico foi adequado em 93% dos menores de 5 anos e em 56% dos maiores de 5 anos. No caso dos portadores de transtornos de neurodesenvolvimento com mais de 5 anos, 46% apresentavam transtorno de aprendizagem, 39% transtorno de conduta, 32% transtorno de linguagem, 10% déficit intelectual. 56% estavam na escola, todos em escolas públicas. No caso dos que não frequentaram a escola, 4 deles estavam em idade em idade escolar obrigatória (6, 7, 9 e 10 anos). 20% das crianças/adolescentes repetiram pelo menos um ano na escola ou no ensino médio. Dados perinatais: 14% das mães usavam drogas; pasta base de tabaco e maiormente pasta base de cocaína (PBC). 85% eram recém-nascidos a termo, 10% tinham depressão neonatal. 15% das crianças/adolescentes foram expostos à violência doméstica e 32% deles (12/38) tinham pelo menos um dos pais que usava drogas psicoativas em casa. 21% das crianças/adolescentes expostas à violência doméstica tinham dificuldade de aprendizagem. 8% desses pacientes possuíam pelo menos um dos pais com escola primária incompleta e 28% com ensino médio incompleto. Encontrou-se relação significativa entre o uso de drogas psicoativas, declarado por um ou ambos os pais, e a violência doméstica. Não foi encontrada relação significativa entre transtornos do neurodesenvolvimento e violência doméstica. Conclusões: esses achados mostram uma população social e economicamente vulnerável, pais com baixa escolaridade, uso de pasta base de cocaína durante a gravidez em porcentagem superior ao reportado a nível nacional, e 15% de crianças/adolescentes expostos à violência doméstica, mas com um alto número de controles de saúde. A maior fortaleza encontrada por este estudo é a importância de manter um bom vínculo com essas famílias, que demonstraram alto nível de comprometimento com o centro de saúde. Isso nos leva a priorizar a prevenção e promoção da saúde como ferramentas valiosas para a aquisição de saúde de qualidade para essas crianças/adolescentes. Novos estudos, com outras metodologias, serão necessários para poder analisar essas variáveis encontradas.

Easing Cash Assistance Rules During COVID-19 Was Associated With Reduced Days Of Poor Physical And Mental Health.

Unemployment rates soared at the beginning of the COVID-19 pandemic in the US, increasing financial stress that can affect physical and mental health. Temporary Assistance for Needy Families (TANF) is the primary cash assistance program for low-income families in the US, with benefits conditional on work activities and subject to suspension. However, many states loosened requirements during the pandemic. Using TANF policy data and data from the Behavioral Risk Factor Surveillance System from the period January 2017-December 2020 with a triple-difference design, we found a general protective effect of supportive changes to TANF on poor physical and mental health days and binge drinking during the COVID-19 pandemic for likely TANF participants. For example, providing emergency cash benefits to those not already participating in TANF, waiving work requirements, waiving or pausing sanctions, and automatically recertifying benefits were associated with reductions in the number of mentally unhealthy days. This study provides support for increasing generosity and easing administrative burdens in safety-net programs to buffer against negative impacts of public health and economic crises.

Theorizing on neo public assistance: How do race and class impact resource uptake and behavior following disaster?

The consequences of environmental disasters and other ecologic and communal crises are frequently worst in racially/ethnically minoritized and low-income populations relative to other groups. This disproportionality may create or deepen patterns of governmental distrust and stoke health promotion disengagement in these groups. To date, there has been limited contextualization of how historically disenfranchised populations utilize government-administered or facilitated resources following such disasters. Focusing on the water crisis in Flint, Michigan, we examine and theorize on the usage of neo public assistance, free risk reduction resources that are provided to disaster survivors as a liminal means of redressing ills created and/or insufficiently mitigated by the state. We surveyed 331 Flint residents, evaluating their usage of four neo public assistance resources following the FWC, finding low to moderate uptake: 131 residents (39.6%) indicated that they obtained blood lead level (BLL) screenings, 216 (65.3%) had their tap water tested for lead (Pb) and other contaminants, 137 (41.4%) had their home water infrastructure replaced, and 293 (88.5%) had acquired bottled water at community distribution sites. Unemployment, receiving public benefits, and lacking reliable transportation and stable housing were associated with lower uptake of some resources. Compared to White and "Other" race individuals, Black residents were generally more likely to acquire/utilize these resources, suggesting heightened concerns and health promotion proclivities even in the face of observed macro and individual-level challenges. Potential reasons and implications are discussed.

The 2016 Presidential Election, the Public Charge Rule, and Food and Nutrition Assistance Among Immigrant Households.

Objectives. To investigate whether the 2016 US presidential election and the subsequent leak of a proposed change to the public charge rule reduced immigrant families' participation in food and nutrition assistance programs. Methods. We used nationally representative data on n = 57 808 households in the United States from the 2015-2018 Current Population Survey-Food Security Supplement. We implemented difference-in-difference-in-difference analyses to investigate whether the election and proposed rule change produced decreases in immigrant families' participation in food and nutrition assistance programs and whether such decreases varied according to state policy generosity toward immigrants. Results. Findings indicate significant and large decreases in Supplemental Nutrition Assistance Program, School Breakfast Program, and National School Lunch Program participation among immigrants in moderately generous states but no changes to receipt of food assistance from nongovernmental sources or to household food insecurity. Conclusions. Both anti-immigrant rhetoric and the perceived threat of policy enactment can be enough to produce chilling effects that have potentially serious implications for the health of immigrant households and thus the health of the nation. (Am J Public Health. 2022;112(12):1738-1746. https://doi.org/10.2105/AJPH.2022.307011).